Tendonitis of the tendons that run behind the inside ankle bone (medial malleolus) can be very painful. Standing and walking are usually limited by pain. It can be hard to flex the ankle and impossible to raise up on your toes. The Flexor Hallucis Longus passes behind the ankle and under the arch to the big toe. It flexes the big toe and and is important in the push of phase of walking and running, helping to propel you forward. The Flexor Digitorum Longus passes behind the medial malleolus and under the foot to attach to the 2nd thru 5th toe, acting to flex the toes. The Posterior Tibial Tendon passes immediately behind the medial malleoli and is important in supporting the arch. Wearing a shoe with a heel and good arch supports can help relieve some of the pain and reduce strain on the tendons. Adding additional arch support can also be helpful. Dr. Scholl’s Hidden Arch Supports are available in local stores and are an inexpensive solution to try. Physical therapy can be helpful with modalities such as ultrasound, electrical stimulation, cold laser, manual therapy and appropriate exercies. Tendonitis is an inflammatory process and will often be aggravated by too much exercise. It is important to do gentle movement, flexing the foot up and down as well as side to side, but aggressive exercise will aggravate the symptoms and should be avoided.